Surgeons Describe 1st U.S. Face Transplant

May 6, 2009 -- The nation's first full face transplant gave Connie Culp what dozens of painful plastic surgeries could not -- the ability to re-enter life.

Culp, a 46-year-old mother of two from Ohio, didn't die four years ago when her husband pulled the trigger of a shotgun aimed at her face. But she lost every semblance of a normal existence.

The middle of her face was gone. She lost one eye, her nose and sinuses, her cheekbone, her upper jaw, and the bone, muscles, and skin that hold a face together. Her facial nerves were torn away.

Culp couldn't breathe without a tube in her neck. She could not drink from a cup, smell, or taste. Despite the best efforts of reconstructive plastic surgeons, a tight and extremely painful shell of scar tissue grew over the wound.

Perhaps even more painful to Culp, people saw her as a monster.

"We tried to assimilate her into society, but she had a difficult time," Cleveland Clinic plastic surgeon Risal Djohan, MD, tells WebMD. "Kids ran away from her and people stared at her."

"Our patient was called names and was humiliated," Cleveland Clinic transplant team leader Maria Siemionow, MD, PhD, said at a news conference. "You need a face to face the world."

Culp now has that face, thanks to an anonymous donor and to Siemionow's 17-member surgical team. The donor, a woman of about the same age and complexion as Culp, died of a head injury that left her face and neck intact.

In an astonishing 23-hour operation, the team was able to remove the donor's face -- nearly the entire face except for the upper eyelids, forehead, lower lip, and chin -- and connect it to Culp's blood vessels and nerves. Although they'd practiced over and over again on cadavers, the team didn't know for sure that the operation would be a success.

That changed when Culp's blood began to flow into the transplant, and the pale white skin became a rosy pink.

"It was a joyful moment to see the lighting up of the face," Djohan said. "It was like the lighting up of a Christmas tree."